Provider Demographics
NPI:1164560538
Name:ROSENBAUM, DAVID STANLEY (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STANLEY
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1275 SHERMER RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4558
Mailing Address - Country:US
Mailing Address - Phone:847-480-1578
Mailing Address - Fax:847-480-1579
Practice Address - Street 1:1275 SHERMER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4558
Practice Address - Country:US
Practice Address - Phone:847-480-1578
Practice Address - Fax:847-480-1579
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice